Are you an Idaho resident who needs health insurance? We understand that the cost of health insurance is higher than it’s ever been before. But believe it or not, there are options. You don’t have to go without coverage a moment longer. Whether you’re eager to take advantage of a federally subsidized ACA plan, or whether you’re looking for more affordable, alternative options, you have more choice than you think. In this article, we’re going to explain some of the more popular options to you so that you can make a well-informed and financially sound decision about your health care needs.
Major Medical Insurance in Idaho
Shortly after the Affordable Care Act was passed in 2010, the federal Health Insurance Marketplace – also known as the Exchange – came into being. Some states, like Idaho, received permission to create their own state-level exchanges which serve the exact same purpose as the federal Health Insurance Marketplace. As an Idaho resident, you should start by going to YourHealthIdaho.org where you can go file an application, see whether or not you qualify for a subsidy, and then shop for a major medical health insurance plan. Now that there is no longer an individual mandate on the federal level or on the state level in Idaho, doing so is 100% optional; but it is also 100% worth it to see if you qualify for a low-cost, subsidized plan.
Most Americans must wait until the Open Enrollment period begins on November 1st each year in order to fill out their application and apply for coverage. However, you may qualify for a special enrollment period if you experience any major life changes, such as moving or having a baby. Once you enroll, you will find out whether you qualify for a subsidy, and you will have access to the Marketplace so that you can shop between different plans and choose the coverage that best fits your needs.
The reason most people try and apply for an ACA plan from the Health Insurance Marketplace first is because of their guaranteed issue status, and the guaranteed medical benefits. But let’s start by talking about the guaranteed issue. When you purchase a guaranteed issue policy through the Health Insurance Marketplace, you cannot be rejected for coverage no matter what pre-existing conditions you may have. Furthermore, your insurance provider can only charge you a higher premium based on the following four variables:
- Your age
- Your location
- Your use of tobacco products
- Whether you are applying for an individual policy or a family policy
Then there are the guaranteed Essential Health Benefits. There are 10 in total, and medical experts have agreed that these 10 benefits are the bare minimum that every major medical health insurance policy should provide in order to foster optimal health and wellness for people. Those benefits include:
- Ambulatory/outpatient services
- Emergency services
- maternity/newborn care
- Mental health and substance abuse
- Prescription drugs
- hab/rehab services and devices
- Lab tests
- Preventive and wellness services and chronic disease management
- Pediatrics (including oral and vision)
For most people who aren’t getting health insurance through their employer, paying for such a comprehensive health plan is prohibitively expensive. But that’s not the case for qualifying Idaho residents. If you are making somewhere between 138% and 400% of the federal poverty level based on your household size, you will qualify for a financial subsidy that can make these insurance plans much more affordable. If you are making 100% or below the federal poverty limit, then you will be better off applying for Medicaid through the Idaho Department of Health and Welfare – but keep in mind that qualifying for Medicaid is based on more than just your income.
|Household Size||Annual Income (138% of FPL)||Annual Income (100% of FPL)|
And if you fall somewhere between 100% And 138% of the federal poverty limit, that’s where things get a little tricky. The good news is that Idaho has just recently joined the club of states which have agreed to accept federal funds to expand Medicare for people who fall into this coverage gap. The bad news is that this doesn’t apply until the year 2020. But there are options you can utilize in the meantime, such as short-term health insurance.
Short Term Health Insurance in Idaho
Most people who look into short-term health insurance in Idaho are doing so either because they can’t afford an unsubsidized ACA major medical plan, or because they fall into the coverage gap we just mentioned. Regardless, being an Idaho resident entitles you to some extra choices that residents of other states can’t get right now. You can choose between a regular short-term health insurance plan while you wait for Medicare expansion to kick in, or you can choose an enhanced short-term plan that will last you a whole year (and is renewable, unlike the standard short-term plans). These short-term plans may also include up to nine of the ten guaranteed Essential Health Benefits, and will likely not come with any pre-existing condition clauses. But giving these plans off the ground and available for consumers is still in the planning stages, and may change in the near future.
Regardless of whether you go with an enhanced plan or a standard plan, you will get much more robust consumer protections compared to other forms of non-ACA health coverage. So you don’t have to lie awake at night worrying about what to do if your healthcare provider denies your claim. You can simply take them to court and dispute it. Many short-term health insurance providers offer you the option to customize your coverage so that you can get almost as many of the guaranteed Essential Health Benefits you want even though the law doesn’t require them to sell you that coverage. You won’t have to apply through any Exchange in order to get short-term coverage; you can just apply directly with the company. And the thing that makes short-term health insurance plans the most attractive to consumers is the fact that they can cost upwards of 33% less than an unsubsidized health insurance plan through Your Health Idaho or the ACA Health Insurance Marketplace.
The extra provisions such as the no pre-existing conditions clause and the attempt by lawmakers to mandate Essential Health Benefits for the enhanced short-term health insurance plans in order to make them competitive with the ACA takes away many of the disadvantages that are inherent in short-term coverage. But there is still some uncertainty which exists around these plans, their exact availability, and how much they might cost you in the long run. If you’re interested in one of these plans, you should keep yourself abreast of the situation and check back for the latest news and updates as things unfold. And don’t be afraid to ask questions if you reach out and contact an enhanced short-term health insurance provider near you who is familiar with the developing status of the law and the plans they are legally allowed to offer.
Christian Health Plans/Health Share Plans in Idaho
Alternatively, you could look into a Christian health plan or health share plan. Much like short-term health insurance, these are not considered adequate replacements for major medical health insurance; however, if you choose a share plan with a religious designation, that would hypothetically exempt you from an individual mandate. But since the individual mandate is no longer a concern for Idaho residents, these plans now have to stand on their own two feet based on the merit of their affordability.
These types of plans are usually fairly competitive, financially speaking, with short-term health insurance. Furthermore, as with short-term health insurance, you can expect the following:
- These plans are NOT guaranteed issue
- They will likely have unlimited out-of-pocket costs
- Almost all plans come with lifetime and annual benefit caps
- These plans do not include guaranteed Essential Health Benefits
Also, unlike short-term health insurance in Idaho – especially the closely regulated enhanced short-term plans – there is no government oversight whatsoever when it comes to Christian health plans or health share plans. So if you ever have a dispute over a claim and you feel that you have been unfairly treated, you will likely have to accept your fate because you won’t have any legal recourse. Furthermore, instead of paying a monthly premium, you will be paying a “monthly share amount” to your health plan provider, along with an “unshared amount” or a “personal responsibility amount” as needed in place of where you would normally be charged a deductible, a copay, or some sort of coinsurance. If you get a healthcare plan that is religious in nature, you will likely have to follow certain participation guidelines In order to remain in good standing with your plan. Many of these guidelines will mandate that you cease any and all tobacco use; discontinue the use of illicit drugs and/or alcohol; and may require you to declare a specific faith. But some Idaho residents feel that the assistance they receive paying for their medical care is worth the effort and the cost.
Fixed Indemnity Plans in Idaho
There are different types of fixed indemnity insurance plans you can purchase in the state of Idaho. Those might include hospital plans or doctor plans, or a combination of the two. These plans will pay out a portion of your medical expenses at a fixed rate both in total amount paid and the frequency of payment, be it per day, per week, per month, per event, or per visit. These are not replacements for a major medical plan – as a matter of fact, fixed indemnity coverage is usually sold right alongside major medical coverage in order to make it more affordable. But since the individual mandate is no longer a requirement, using this type of coverage instead of major medical can help reduce your total out-of-pocket costs – just keep in mind you will still be lacking comprehensive, qualifying health coverage.
Fixed indemnity plans, much like a health share plan, are not guaranteed issue. This means that you can and likely will be charged more if you have any unfavorable pre-existing conditions that your insurance company is worried about. There are also no guaranteed Essential Health Benefits associated with fixed indemnity plans. But you can get discounted out-of-pocket medical care for a relatively low monthly premium, so if you are relatively healthy and don’t anticipate needing much care, these alternatives can be reasonably affordable.
Discount Cards in Idaho
Medical discount cards are available to a limited extent in Idaho. They usually come in the form of a prescription discount card, although you may be able to find medical discount cards for vision, dental, or even some basic medical services if you look hard enough. The way these usually work is that you pay a fee, either on a monthly or yearly basis, in order to be a member of the discount program. Then you will get a card issued to you in the mail and you will need to present that card at participating providers and retailers. You will get a discount immediately at the register – there are no claims to file, but there are also no reimbursements to receive. And like most of the options mentioned in this article so far, medical discount cards are not a replacement for major medical insurance coverage.
Because they are not a replacement for major medical coverage, you can purchase a discount card and use it right alongside your regular coverage. This can make your healthcare costs more affordable, especially if you have a plan with a high deductible. But if you don’t have regular coverage, it can help make your medical costs that much more affordable. One last note about these discount plans, however: make sure to do your research before you decide to purchase one of these plans. Not all companies are honest and forthright about the discounts they offer or the providers they claim to be associated with. Be sure to call around and ask as many questions as possible if you think you have found a deal that sounds too good to be true. But if everything checks out on the follow-up, then go ahead and take advantage of those wonderful savings.